WO2004080522A1 - Dispositif et procede pour radiotherapie guidee par dose - Google Patents

Dispositif et procede pour radiotherapie guidee par dose Download PDF

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Publication number
WO2004080522A1
WO2004080522A1 PCT/US2004/006905 US2004006905W WO2004080522A1 WO 2004080522 A1 WO2004080522 A1 WO 2004080522A1 US 2004006905 W US2004006905 W US 2004006905W WO 2004080522 A1 WO2004080522 A1 WO 2004080522A1
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WO
WIPO (PCT)
Prior art keywords
patient
radiation
radiotherapy
dose
real
Prior art date
Application number
PCT/US2004/006905
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English (en)
Inventor
C. Norman Coleman
Robert Miller
Rosemary Altemus
Holly Ning
Alan Lee Huston
Brian L. Justus
Paul Falkenstein
Original Assignee
The Government Of The United States As Represented By The Secretary Of Health And Human Services, National Institutes Of Health
The Secretary Of The Navy
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
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Publication date
Application filed by The Government Of The United States As Represented By The Secretary Of Health And Human Services, National Institutes Of Health, The Secretary Of The Navy filed Critical The Government Of The United States As Represented By The Secretary Of Health And Human Services, National Institutes Of Health
Priority to EP04717501A priority Critical patent/EP1608427B1/fr
Priority to CA2518769A priority patent/CA2518769C/fr
Priority to AT04717501T priority patent/ATE528039T1/de
Priority to AU2004220539A priority patent/AU2004220539B8/en
Publication of WO2004080522A1 publication Critical patent/WO2004080522A1/fr
Priority to US10/548,391 priority patent/US7554090B2/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A61N5/1071—Monitoring, verifying, controlling systems and methods for verifying the dose delivered by the treatment plan
    • A61N2005/1072—Monitoring, verifying, controlling systems and methods for verifying the dose delivered by the treatment plan taking into account movement of the target
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A61N5/1064—Monitoring, verifying, controlling systems and methods for adjusting radiation treatment in response to monitoring
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A61N5/1071—Monitoring, verifying, controlling systems and methods for verifying the dose delivered by the treatment plan

Definitions

  • This invention relates to radiotherapy, such as the treatment of tumors in patients by radiation directed from linear accelerators or from radio active material (e.g. brachytherapy sources). More specifically, a grid of fiber optic radiation dosimeters detects in real-time the dose pattern of radiation administered. This real-time dose pattern is compared to a predicted dose pattern of targeted radiation being administered to a patient. Dosage is gated between a low radiation dose monitoring state and the prescribed radiation dose state responsive to coincidence of the predicted dose pattern to the real-time dose pattern. Radiation therapy with reduced margin and increased target dosage is enabled.
  • radiotherapy such as the treatment of tumors in patients by radiation directed from linear accelerators or from radio active material (e.g. brachytherapy sources). More specifically, a grid of fiber optic radiation dosimeters detects in real-time the dose pattern of radiation administered. This real-time dose pattern is compared to a predicted dose pattern of targeted radiation being administered to a patient. Dosage is gated between a low radiation dose monitoring state and the prescribed radiation dose state responsive to coincidence
  • an optically-stimulated luminescent radiation dosimeter system includes a radiation-sensitive optically-stimulated dosimeter which utilizes a doped glass material, disclosed in Huston et al. United States Patent 5,811,822 entitled Optically Transparent, Optically Stimulable Glass Composites for Radiation Dosimetry, disposed at a remote location for storing energy from ionizing radiation when exposed thereto.
  • the doped glass material releases the stored energy in the form of optically-stimulated luminescent light at a first wavelength when stimulated by exposure to light energy at a stimulating second wavelength.
  • a fiber-optic waveguide communicates the released light to a photo detector at a remote location. Radiation dosage is measured in real- time at the remote location.
  • Radiotherapy approaches for treating humans and animals are known. Simply stated, oncologists irradiate tumors or "targets" to retard or eliminate the cancer. A brief review of the state-of-the-art treatment is warranted.
  • An oncologist in planning treatment physically examines a patient, looks at the patient's pathology, and observes previously generated patient images. Using all this information, the oncologist generates a treatment plan.
  • This plan includes irradiating the tumor (hereafter target) at multistage intervals (for example, 36 discrete treatments or fractions) along a group of paths with the target at the point of path intersection. Since the radiation passes through healthy tissue on its way to and from diseased tissue, multiple paths for the administration of radiation are chosen. In that way, damage to healthy tissue is minimized and irradiation of the target maximized because of its location at the intersection of the group of paths.
  • the patient is placed in a treatment position and CT, MRI, PET and other images and scans are generated.
  • the scans are fused to produce a three-dimensional digitized image of the patient in the treatment position.
  • the target is identified in the three-dimensional digitized image of the patient.
  • radiation treatment is delivered to the target through the patient in accordance with the oncologist's plan.
  • the oncologist typically predicts the total dosage delivered to the target utilizing known software in conjunction with his or her generated treatment plan. Dosage delivered at each discrete treatment can be the subject of a predicted irradiation pattern, usually at the target within the patient. In fact, the predicted irradiation pattern can be determined for any points within the three-dimensional digitized image obtained for the treatment plan.
  • a method of and apparatus for dose-guided radiotherapy for a patient having an identified radiotherapy target utilizes a radiation detecting array of radiation-sensitive dosimeters for the real-time remote measurement of radiotherapy at the radiation detecting array.
  • the radiation detecting array is either placed within the patient along the treatment path before or after the identified radiotherapy target or exterior to the patient.
  • a radiation source for emitting radiation along a treatment path through the patient to the identified radiotherapy target is utilized.
  • the method includes generating a predicted dose pattern of radiation at the placed radiation detecting array. The predicted dose pattern assumes an on- target radiation source emitting the radiation along the treatment path through the patient to the identified radiotherapy target.
  • the predicted dose pattern of radiation is compared to the real-time dose pattern at the radiation detecting array to determine, in real-time, radiation coincidence to the identified radiotherapy target in the patient.
  • the radiation detecting array can be placed adjacent to the identified radiotherapy target within the patient, or exterior to the patient. Gating of the radiation source can occur responsive to the comparing of the predicted dose pattern of radiation to the real-time dose pattern at the radiation detecting array.
  • the radiation dose rate is controlled by varying the rate at which the radiation pulses are generated.
  • the treatment continues in the manner prescribed by the oncologist. If the dose image does not correspond to the predicted dose pattern, then intervention is required to reposition the patient or the beam to obtain coincidence between the measured and predicted radiation patterns. The degree of coincidence between the measured dose image and the predicted dose pattern is monitored continuously during the treatment procedure. If at any time during the treatment, the measured dose image does not correspond to the predicted dose pattern, the treatment will be stopped and appropriate steps will be taken to reestablish proper coincidence.
  • the radiation detecting array constitutes an improvement to the apparatus for radiotherapy. When combined with hardware that provides memory and image processing capabilities for comparing the predicted dose pattern to the real-time dose pattern at the array, a new apparatus for radiotherapy is disclosed.
  • Fig 1 A is a perspective view of a patient on a supporting table underlying a linear accelerator schematically illustrating radiation treatment to the lung with a dose meter array located exterior of the patient and below the table supporting the patient;
  • Fig IB is a block diagram illustrating the controlling computer logic including comparing the predicted image with a real-time image to gate the linear accelerator for patient treatment;
  • Fig 2 is a schematic view of the patient illustrating a treatment plan having three discrete angles for radiation treatment to a target located within the patient;
  • Fig 3 A is a schematic layout of an internal dosimeter probe array showing a detector array together with fiducial markers;
  • Fig 3B is a schematic layout of an internal dosimeter probe array in conjunction with a catheter having ancillary apparatus for use in conjunction with the dosimeter probe array;
  • Fig 4A is a predicted image of a patient having prostate cancer illustrating the cancer located in the pelvic area with the cancer target identified;
  • Fig 4B is a predicted image in the vicinity of the prostate illustrating the target on an expanded basis
  • Fig 4C is a perspective view of non coincidence between the predicted image and the real-time dosimeter image of the prostate resulting in gating of the accelerator to a low radiation monitoring level;
  • Fig 4D is a perspective view of coincidence between the predicted image and the real-time dosimeter image of the prostate resulting in gating of the accelerator to a prescribed treatment level;
  • Fig 5 A is a predicted image of a patient having lung cancer illustrating the cancer located in the chest area with the target identified;
  • Fig 5B is an predicted image in the vicinity of the lung illustrating the target on an expanded basis
  • Fig 5C is a perspective view of non coincidence between the predicted image and the real-time dosimeter image of the lung resulting in the gating of the accelerator to a low radiation monitoring level;
  • Fig 5D is a perspective view of coincidence between the predicted image and the real-time dosimeter image of the lung resulting in the gating of the accelerator to a full treatment level;
  • Fig. 6A is a schematic section taken through the body of a patient resting on a pad of tissue equivalent gel with an array disposed within the tissue equivalent gel; and, [0029] Fig. 6B is a schematic plan of Fig. 6 A.
  • a patient P is shown positioned on table T underlying accelerator A.
  • a real-time dosimeter array R is shown schematically positioned below table T.
  • array R can be positioned either interior of the patient, as for example in an inserted catheter at or near the identified radiotherapy target, or positioned at the exterior of the patient along the treatment path from the radiotherapy target, as for example being positioned coincident to the table surface after the radiation has passed tlirough the patient.
  • Computer C is illustrated below table T; it will be realized that the location of the computer is completely discretionaiy.
  • the accelerator A operates by generating short ( ⁇ 5 -microsecond) pulses of radiation.
  • the overall quantity of radiation administered to the patent is determined by the total number of pulses that the patient receives.
  • the dosage rate changes from a few pulses per unit time where the patient is out of position to a prescribed treatment level where the patient is in position.
  • linear accelerator A In the preferred embodiment here, we use a linear accelerator A. It will be understood that other radiation sources will operate as well. For example, one can use this on radiation sources other than linear accelerators, including radioactive sources such as cobalt 60, iridium, iodine, palladium, and particle beams including protons, electrons and neutrons.
  • radioactive sources such as cobalt 60, iridium, iodine, palladium, and particle beams including protons, electrons and neutrons.
  • a block diagram illustrating gating of the accelerator A is shown.
  • a predicted image 10 is input to the computer.
  • the predicted image 10 is conventionally generated by merging area scans.
  • patient P is placed in the treatment position. Thereafter, the patient is subject to a number of scans.
  • the scans can include magnetic resonance imaging (MRI), computer-generated tomo graphic scans (CT), and the like. Once these discrete scans are generated, they are conventionally merged to produce the predicted images.
  • MRI magnetic resonance imaging
  • CT computer-generated tomo graphic scans
  • Such conventionally produced predicted images are illustrated with respect to Figs 4A, 4B, 5A, and 5B.
  • Real-time image 11 is generated from array R.
  • Huston et al. United States Patent No. 6,087,666 issued July 11, 2000 entitled "Optically Stimulated Luminescent Fiber Optic Radiation Dosimeter” a dosimeter having broad dynamic range is disclosed for radiation having ionizing effect on the disclosed dosimeters. Simply stated, over a dose range including approximately six orders of magnitude, the disclosed dosimeter can remotely report, in real-time, the radiation received.
  • the dosimeter array R can vary from that disclosed in Huston et al. United States Patent 6,087,666.
  • scintillating optical fibers or electronic detector arrays can be used.
  • the term "radiation detecting array” includes electronic portal imaging technologies. In short, any array which is capable of producing from the treatment radiation source a real-time image of, at, or adjacent to, the radiotherapy target or along the treatment path from the radiotherapy target exterior to the patient will suffice.
  • the contrast level of the real-time image array 11 can be altered so that during full intensity treatment the real-time dose being administered to the patient produces a real-time image which can be compared to the predicted image. If during the full intensity treatment the target moves, gating of the accelerator to the low radiation level per unit of time can occur.
  • Predicted image 10 will in the normal case be quite complete. For example, by merging soft tissue discriminatory scans such as MRI scans with bone density discriminatory scans such as CT scans, images such as those generated in Figs B and 5B can be routinely generated. This is to be contrasted with real-time image 11.
  • real-time image 11 it is only necessary to sample the image produced by the linear accelerator A. For example, and taking the schematic layout of the internal dosimeter probe illustrated in Fig 3 A, it will be seen that only 8 sample points are included for the real-time image 11. With 8 such points, coincidence or non coincidence between predicted image 10 and real-time image 11 can be determined. It should be noted that sampling a larger number of points will result in greater precision.
  • coincidence gate 14 emits a signal 16 to accelerator gate 15 to fully open accelerator control 19 causing accelerator A to emit tlirough accelerator control 19 a treating beam of the prescribed dosage per unit of time.
  • coincidence gate 14 emits a signal 17 closing down gate 15.
  • the accelerator control 19 emits a signal to accelerator A causing radiation to be emitted at the low level.
  • FIG. 3A and 3B two varieties of the arrays utilized with this invention are illustrated.
  • an array R positioned with respect to catheter 30 is illustrated.
  • the array R is of the type that is best utilized for insertion to the patient P being treated. For example, it can be used as a rectal probe during treatment of prostate cancer, as illustrated in Fig 4 A and 4B hereinafter.
  • Catheter 30 includes fiducials 31 which can measure the colon center line invasion of the catheter to a site proximate to the prostate cancer being treated. Fiducials 31 not only determine the proximity of the catheter 30 to the treated prostate but additionally can be used to orient the array with respect to the radiation beam after the catheter is being administered to the patient.
  • catheter 30 includes remote fiber monitors 32 constructed in accordance with Huston et al, 6,087,666. These remote fiber monitors 32 and fiducials 31 are typically disposed on a cylindrical structure with the dosimeter probes 32 and the fiducial markings arranged around the periphery. As such, the probes and fiducials are arranged in a three-dimensional arrangement. Once positioned, the rectal probe stabilizes the position of the prostate gland, preventing it from moving during the course of the therapy session.
  • accelerator A is typically gated to a low level. At this low level, the beam from accelerator A can produce high contrast image points at each of the remote fiber monitors 32. Presuming a high contrast image of the prostate sections that are illustrated in Fig 4B, the discrete sample points of the remote fiber monitors 32 will sample the real-time image 11 relative to the predicted image 10. Where coincidence is present, accelerator A will be gated to full treatment level.
  • catheter (or probe) 30' is illustrated in more detail.
  • the remote fiber monitors 32 are shown disposed from a base 33. These monitors 32 are typically disposed in a tliree dimensional array within catheter 30'.
  • Ultrasound probe 34 is shown disposed within catheter 30' to enable ultrasound imaging to assist catheter positioning.
  • Catheter 30' includes an inflatable cuff that holds the catheter firmly in place and stabilizes the position of the target (for example, the prostate gland illustrated in Fig. 4) during the course of the radiotherapy session.
  • drug delivery compartment 35 and drug delivery sampler 36 are illustrated. Typically compartment 35 and sampler 36 enable radiation mitigating drugs to be administered to the patient P.
  • catheter 30' is inserted rectally to be proximate to cancer of the prostate, it is desirable that the radiation have minimal effect on the tissue of the rectum.
  • the optimum presence of the radiation mitigating drugs can be maintained throughout the desired treatment.
  • array R is shown below to the top of table T.
  • FIG 1 A an array of the remote fiber monitors 32 is shown below the top of table T. Regarding such arrays, they can be placed on planes exterior of the patient which are typically normal to the beam of radiation from accelerator A. Referring back to Fig 1 A, the array R there illustrated is shown below the level of table T. Alternately, arrays R can be co-incident to the top of table T.
  • the array could just as well be a freestanding plane aligned with respect to both the patient, table and accelerator but exterior of the patient.
  • an array R could be placed on the table canted to an angle so as to be normal to the beam of radiation from the accelerator.
  • the patient P having a cancer target 50 will be treated by radiation from the accelerator A from a number of different angles. All treatment paths will typically be coincident to the cancer target 50. At the same time, the treatment paths will have differing entrance and exit paths. This will be done to minimize radiation to healthy tissue and to concentrate radiation on diseased tissue.
  • FIG 4 A an image of the pelvic region of a patient having prostate cancer is illustrated.
  • Fig 4B the area immediate to the diseased prostate is shown in an expanded view. This area shows cancer target 50 outlined with respect to the prostate.
  • prostates are notorious for movement. First, patient nervousness can cause muscular flexure in the vicinity of the pelvis. Pelvic movement with resultant prostate movement results. Moreover, gas in the rectum can effect overall prostate movement. Furthermore, the patient (especially during initial treatment) can himself dynamically (and nervously) move. Simply stated, the prostate is a dynamic target during radiation treatment.
  • FIG 4C an oversimplified view of non coincidence between predicted prostate image 60 and real-time prostate image 61 is illustrated.
  • the images are shown to be exactly the same but displaced with respect to the collimated radiation emitted from accelerator A.
  • non coincidence of the images will not be as simple.
  • the content of predicted prostate image 60 and real-time prostate image 61 will be two discreetly different images, much as two pictures of the same human face with two different expressions will be discreetly different images.
  • array R samples real-time prostate image 61 coincidence to predicted prostate image 60 will not occur. Accordingly, accelerator A will be gated to emit a low level of radiation.
  • Fig 4D a view of coincidence between predicted prostate image 60 and real-time prostate image 61 is illustrated.
  • the images are shown to be exactly the same and registered with one another with respect to the collimated radiation emitted from accelerator A. Presuming that array R samples real-time prostate image 61 coincident to predicted prostate image 60 will occur. Accordingly, accelerator A will be gated to emit a full intensity treatment of radiation.
  • Fig 5A an image of the patient having lung cancer is illustrated in the vicinity of the chest and rib cage. Presuming that the cancer target 50 is on a surface of the lung, a target having unusual dynamic excursion is illustrated.
  • FIG. 5B the area immediate to the diseased lung is shown in an expanded view. This area shows cancer target 50 outlined with respect to the portion of the lung shown.
  • FIG 5C an oversimplified view of non coincidence between predicted lung image 70 and real-time with lung image 71 is illustrated. Again the images are shown to be exactly the same but displaced with respect to the collimated radiation emitted from accelerator A. Again non-coincidence of the images will not be as simple. Accordingly, accelerator A will be gated to emit a low level of radiation.
  • Fig 5D a view of coincidence between the predicted lung image 70 and real-time lung image 71 is illustrated.
  • the images are shown to be exactly the same and registered to one another with respect to the collimated radiation emitted from the accelerator A. Presuming that array R samples real-time lung image 71, coincidence to predicted lung image 70 will occur. Accordingly, accelerator A will be gated to emit a full intensity treatment of radiation.
  • pad D containing tissue equivalent gel G is shown disposed on table T.
  • An array R is contained within the gel G.
  • Pad D and gel G conforms to the patient's body so that there is no air gap between the body and the detector array.
  • the MRI and CT scans are performed with the gel/detector array in position so that current treatment planning systems can be utilized to determine the dose distribution at the position of the array.
  • array R placed outside the body can be utilized without determining dose distribution leaving the skin of the patient and proceeding tlirough atmosphere.
  • array R could be contained within conformable pad which is wrapped tightly to the patient's skin.

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Pathology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Radiology & Medical Imaging (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Radiation-Therapy Devices (AREA)
  • Apparatus For Radiation Diagnosis (AREA)

Abstract

L'invention concerne un dispositif et un procédé pour radiothérapie guidée par dose, destinés à un patient présentant une cible radiothérapeutique identifiée et qui emploient un réseau de détection de rayonnement, formé par des dosimètres sensibles au rayonnement, pour prendre des mesures radiothérapeutiques à distance en temps réel au réseau de détection de rayonnement. Ledit réseau est positionné dans le corps du patient, sur un trajet de traitement, avant ou après la cible radiothérapeutique identifiée, ou le dispositif peut être positionné hors du patient pour mesurer la dose de transit. Une source de rayonnement est utilisée pour émettre un rayonnement radiothérapeutique sur le trajet de traitement, dans le corps du patient, vers la cible radiothérapeutique identifiée. Le procédé comporte les étapes consistant à : produire un motif de dose prédite de rayonnement au réseau de détection de rayonnement mis en place. Ledit motif utilise une source de rayonnement sur cible qui émet le faisceau radiothérapeutique sur le trajet de traitement, dans le corps du patient, vers la cible radiothérapeutique identifiée. La source de rayonnement peut être activée en réponse à la comparaison entre le motif de dose prédite de rayonnement et le motif de dose mesuré en temps réel au réseau de détection de rayonnement. L'intensité du rayonnement peut varier entre des niveaux faibles et un niveau de traitement en réponse à la coïncidence entre le motif de dose prédite de rayonnement et le motif de dose mesuré en temps réel au réseau de détection de rayonnement.
PCT/US2004/006905 2003-03-11 2004-03-04 Dispositif et procede pour radiotherapie guidee par dose WO2004080522A1 (fr)

Priority Applications (5)

Application Number Priority Date Filing Date Title
EP04717501A EP1608427B1 (fr) 2003-03-11 2004-03-04 Dispositif pour radiotherapie guidee par dose
CA2518769A CA2518769C (fr) 2003-03-11 2004-03-04 Dispositif et procede pour radiotherapie guidee par dose
AT04717501T ATE528039T1 (de) 2003-03-11 2004-03-04 Vorrichtung für dosisgesteuerte strahlentherapie
AU2004220539A AU2004220539B8 (en) 2003-03-11 2004-03-04 Apparatus and process for dose-guided radiotherapy
US10/548,391 US7554090B2 (en) 2003-03-11 2005-03-04 Apparatus and process for dose-guided radiotherapy

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US45393403P 2003-03-11 2003-03-11
US60/453,934 2003-03-11

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WO2004080522A1 true WO2004080522A1 (fr) 2004-09-23

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US (1) US7554090B2 (fr)
EP (1) EP1608427B1 (fr)
AT (1) ATE528039T1 (fr)
AU (1) AU2004220539B8 (fr)
CA (1) CA2518769C (fr)
WO (1) WO2004080522A1 (fr)

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EP1608427A1 (fr) 2005-12-28
AU2004220539A1 (en) 2004-09-23
EP1608427B1 (fr) 2011-10-12
CA2518769C (fr) 2012-07-17
AU2004220539B2 (en) 2010-09-02
AU2004220539B8 (en) 2011-01-06
CA2518769A1 (fr) 2004-09-23
US20070058778A1 (en) 2007-03-15

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